Interview guide questions.

The postnatal period is a critical transition period for first-time mothers, especially adolescents. An indication of maladaptation with this transition is the experience of poor mental health by some adolescent mothers. Social and collective cultural factors have been claimed to influence maternal mental health during the postnatal period; however, there is limited research focusing on cultural and social factors that influence adolescents’ mental health during the postnatal period in rural Malawi. Therefore, we explored the perceived cultural and social factors that influence mental health among adolescent mothers during the postnatal period in rural Malawi. A descriptive qualitative design (DQ) was employed. Data were collected from September 7th, 2021, to March 31st, 2022, from a convenience sample of 395 adolescent mothers. Reflexive thematic analysis was employed using open coding. Codes were grouped into categories and themes derived using inductive thinking. Adolescent mothers’ mental health was found to be influenced by interactions between social and cultural factors within all levels of the Social Ecological Model of Health (SEM). Four main themes, health and mental health awareness, relationships, family support, and rite of passage, explained social and cultural influences for adolescent mothers in Malawi. There is a need for collaborative, coordinated, and co-designed efforts to implement integrated, comprehensive, and culturally appropriate interventions at each level of SEM influence to promote adolescent’ mothers’ mental health. Specifically, policies should focus on the prevention of early marriages, improved access to reproductive health services, and long-term interventions to promote family involvement in the care of mothers. Healthcare systems should offer accessible mental health support for adolescent mothers.